Lower limb reconstruction using propeller flaps

Abstract

Background: The islanded pedicled perforator-based propeller design flap is a versatile local flap for reconstruction of defects of lower limbs from knee to leg to ankle to foot. Patients and Methods: All patients with small-and moderate-sized defects in lower limbs which required a flap cover are included in the study. Between October 2014 and September 2015, prospective study of patients undergoing perforator-based propeller flap procedure was performed. Patients were evaluated for defect size, defect location, procedure done, and donor site cover. Results and complications of the propeller flap were also analyzed. Atotal of eight flaps were done to cover defects of lower limbs. Results: Out of the eight flaps, seven were islanded on posterior tibial artery, one on the lateral geniculate artery perforator. Four flaps were used to cover lower one-third leg, three for middle one-third leg, and one for knee. The flap dimensions ranged from 3 cm×7 cm to 7 cm×19 cm. The median angle of rotation was 160°(ranging from 60° to 180°). Sixty-three percent of patients had associated fractures. Seven flaps survived completely and one flap had partial necrosis, which was managed with secondary split skin grafting. Conclusion: The islanded propeller design pedicled perforator flaps provides reliable coverage for small-to medium-sized defects for lower limbs, particularly lower one-third leg defects. This flap can provide an esthetically acceptable result as well.